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Considerations for the Use of Sign Language
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Considerations for the Use of Sign Language
The following Web document addresses the issues surrounding the use of sign language for children who have a cochlear implant. It provides information to help families and professionals understand:
The Debate
Professional opinions in both medical and educational environments vary as to the reasons why sign language should or should not be used with children who have a cochlear implant.
Professionals who advise against the use of manual communication for children with cochlear implant believe that promoting total reliance on, and immersion in, the use of the auditory channel maximizes the potential the implant provides to develop useable hearing and spoken language. These professionals warn that the use of sign language significantly reduces the amount and consistency of post-implantation spoken language stimulation for the child, promoting dependency on visual communication, and causing further delay in spoken language development.
Other professionals maintain that sign language and spoken language can be developed and used to complement and supplement each other. They believe that effective educational environments can be designed to facilitate and maximize a child's language and communication skills in both sign language and spoken language, and that these approaches can work harmoniously to support a child's overall language, cognitive, social, and academic development.
Growing Support for the Use of Sign Language
When cochlear implants first became available, the majority of families choosing this surgery appeared to be those families who were already strongly committed to oral education. As use of the technology has become more widespread, it appears that children who are obtaining implants have a broader range of education, communication, and family environments with a wider range of goals.
An "auditory only" approach to communicating with implanted children is often strongly recommended by hospital implant centers and is an effective choice for many. However, communication approaches involving the development and use of both spoken and signed language for implanted children are gaining support. The choice to implant a child is no longer solely associated with the desire to seek an "oral only" education for him or her.
Of 439 families of school-aged children with cochlear implants questioned in a 1997-1998 survey by the Gallaudet University Research Institute, two-thirds of the families continued to use sign language as a support for communication in the home.* Amy McConkey Robbins, in volume 4, issue 2, of Loud and Clear, a publication of the Advanced Bionics Corporation, states that "a substantial proportion of children with cochlear implants utilize sign language" and that "pediatric implantees" are about equally divided between those who use oral communication and those who use total communication.
While use of solely oral communication strategies may meet the needs of one segment of the population of implanted children, it appears that sign language can have a role in the language, communication, education, and identity of children who use cochlear implants.
Basic Beliefs
In general, persons supporting the use of sign language in the lives of implanted children believe that:
- when parents and children communicate effectively with each other from the very start of hearing loss identification, a foundation for language acquisition (both spoken and signed language) is established and language delays may be prevented or minimized (Yoshinaga-Itano, C., & Sedey, A. (Eds.). 2000. Language, speech, and social-emotional development of children who are deaf or hard of hearing.The Early Years,100(5). Washington, DC: Alexander Graham Bell Association.);
- spoken language can be nurtured and developed in a signing environment when children are provided with the necessary supports;
- sign language and spoken language development are compatible and can support each other in the learning process;
- the use of sign language does not mean exclusion of spoken language development;
- children with a cochlear implant can benefit from interaction with the Deaf community to promote their identity as Deaf individuals;
- deaf children with a cochlear implant, while they may obtain greater access to sound in comparison to traditional hearing aids, are still "deaf" and may benefit from the use of sign language, similar to other deaf children; and
- children with a cochlear implant who are not exposed to sign language and then who do not develop spoken language skills in a timely fashion may become at risk for significant delay in the areas of communication, language, social, and academic development.
Reasons to Consider Sign Language Use for Children with a Cochlear Implant
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There may be a variety of reasons for considering using sign language with implanted children. Some of the reasons include:
- to provide an easily accessible shared language system to readily communicate desires, ideas, wants, and needs (see sidebar);
- to promote language development through a child's strong sense of vision, while the sense of audition develops to become functional and broad enough to shoulder the responsibility of facilitating spoken language;
- to safeguard overall language development related to inconsistent and unknown outcomes in development of spoken language for each implanted child;
- to provide a language foundation to facilitate a child's ability to understand and utilize auditory information; and
- to support communication in different environments, as some implanted children (similar to some hard of hearing children) may be efficient oral communicators for social situations, however, sign language is a necessary support for critical or abstract thinking, problem solving, and assimilating new information in an academic environment.
Varied Roles of Sign Language
While there is increasing support for the use of sign language, it should be acknowledged that the role of sign language might not be the same for each cochlear implanted child and his or her family. Some of the factors that may impact on the degree to which sign language may be used include:
- the extent and nature of sign language use prior to implantation,
- the individual functioning levels in spoken language prior to implantation,
- student preference and/or benefit from the addition of sign language,
- family motivation to include sign language use,
- auditory vs. visual learning styles,
- auditory/language processing skills,
- language development level at the time of the implant,
- family interest in using sign language,
- access to sign language models, and
- peer group identification ("fitting in").
What Literature Reports About Sign Language and Cochlear Implants
Limited research has been done in the area of cochlear implants and the use of sign language. As the earliest group of implanted students were mostly involved in oral environments, there has not been sufficient time to evaluate longitudinal outcomes for implanted students who use sign language. Some of the literature available on the topic of sign language use for implanted children includes the following statements supporting its benefit:
- "Continued use of a total communication approach might be the most effective means for facilitating language growth in a child with a cochlear implant. Nonetheless, it is essential that the child be exposed to an enriched auditory environment for as many hours a day as possible. There is a great need for a strong commitment to maximize the auditory component with a TC approach. In addition, it might be necessary for the school staff to adjust their expectations and teaching priorities, especially if manual communication is the focus of the child's educational placement."
McKinley, A., & Warren, S. (2000). The effectiveness of cochlear implants for children with prelingual deafness. Journal of Early Intervention, 23.
- "It seems that a child who is a good communicator before implantation, whether silently or vocally, is likely to have good speech discrimination ability in later years."
Tait, M., Lutman, M. E., & Robinson, K. (2000). Preimplant measures of preverbal communicative behavior as predictors of cochlear implant outcomes in children. Ear and Hearing, 21, pp 18-24.
- "One observation seems equally sure: Being exposed to two languages from birth, by itself, does not cause delay and confusion to the normal processes of human language acquisition."
Petitto, L. A., Katerlos, M., Levy, B., Gauna, K., Tétrault, K., & Ferraro, V. (2001, June). Bilingual signed and spoken language acquisition from birth: Implications for the mechanisms underlying bilingual language acquisition. Journal of Child Language, 28, pp 453-496.
- "Children may benefit from using cochlear implants regardless of the communication strategy/teaching approach employed by their school program…other considerations, such as the age at which children receive implants, are more important. "
McDonald, C., Hieber, C., Alexander, S., Arts, H., & Zwolan, T. (2000, October). Speech, vocabulary, and the education of children using cochlear implants: Oral or Total Communication? Journal of Speech, Language, and Hearing Research, 43.
- "…it is important that guidelines be developed to identify children who are not benefiting from cochlear implants while they are still young enough to acquire language through other means…the overall cognitive and psychosocial development of children will be negatively affected if they do not have access to a shared language system with which to communicate with family members, other children, and other adults during their early years."
Spencer, P. (2002). Language development of children with cochlear implants. In I. Leigh & J. Christiansen, Cochlear implants in children: Ethics and choices. Washington, DC: Gallaudet Press.
Considerations for Educational Placement
It is necessary for a child to have the opportunity to actively integrate spoken language into his or her educational and home environment if the implant technology is to be maximized for the development of spoken language skills. As placement decisions that include the use of sign language are made, keep in mind that environments that utilize signing vary in the type of sign language used and the extent and nature of spoken language in the environment.
You may encounter the following terminology used when describing educational programs that include sign language: Total Communication, Bilingual/Bicultural, or Dual Language.
- Bilingual/Bicultural (Bi-Bi)—A bilingual approach supports development of American Sign Language (ASL) as a child's first language, with development of English as a second language through reading, writing, and spoken language (specific to each child's potential and needs).
- Total Communication (TC)—Includes the use of all modes of communication—sign language (ASL or manually coded English), spoken language, mime, facial expression, gestures, etc.—to facilitate language development and communication. The intention of this methodology is to provide a child with any modality necessary to support the child in developing language. Its intention is not that all modalities be equally weighted and utilized for all children. The most common embodiment of TC, however, has become simultaneous communication. Simultaneous communication is the use of the spoken word simultaneously with the signed version of all or part of the spoken utterance. The signs used are usually an attempt to match the spoken message.
- Dual Language—A Dual Language program focuses on the use of both ASL and English. English is modeled through Sign Supported Speech and through spoken English alone. First and second language acquisition and use: ASL or English depends on a variety of factors related to the child and family (see Factors Influencing Performance).
Developing Spoken Language in Signing Environments
The following considerations and strategies for supporting the development of spoken language in a signing environment are based on a list generated by 130 administrators, teachers, and support service specialists from throughout the United States and Canada during the conference, "Cochlear Implants and Sign Language: Putting It All Together," sponsored by the Cochlear Implant Education Center at the Laurent Clerc National Deaf Education Center during April 2002. For the full proceedings of this conference, visit: http://clerccenter.gallaudet.edu/Products/Sharing-Ideas/CI/index.html.
For educational environments that use either American Sign Language or other sign language systems to be appropriate environments to facilitate development of spoken language for students with cochlear implants, there must be an ongoing commitment of the program to value these skills and ensure ongoing opportunities for implanted students to develop and use spoken language.
The following list includes suggested strategies to consider for promoting spoken language development in signing environments:
- Develop individual language plans for each student with a cochlear implant—documenting a student's language functioning in spoken and signed language and documenting goals for each of these areas of development. Monitor these goals on an ongoing basis.
- Specify times/activities to utilize either sign language only, spoken language only, or sign and speech together (Sign Supported Speech).
- Alert the child to modality use (i.e., "Now we are going to listen.").
- Incorporate the use of the "sandwich technique" ("say it-sign it-say it," or "sign it-say it-sign it").
- Model and expand signs already known to the child into spoken language. For example, when a child signs ball, repeat back, "Yes, that's a ball."
- Introduce new spoken language in highly redundant and contextual situations. Once the students experience familiarity with spoken language in a structured environment, provide opportunities for each child to use his or her listening skills in expanded environments.
- Provide activities that incorporate sound throughout the day. For example, use timers to designate the end of an activity or music to indicate when it is time to line up.
- For older students, help them make links between spoken language and ASL. For example, explain how a word or a sentence looks in ASL and how it sounds in English.
Further information regarding strategies to facilitate spoken language development with an implant will be discussed in the module, Training the Ear to Listen.
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